Chen Long, Mo Dun-Chang, He Jin-Nian, Du Ke-Jiang, Peng Li-Ping, Yin Shi-Hua
Department of Otorhinolaryngology Head and Neck Surgery, The Second Affiliated Hospital of Guangxi Medical University, Nanning, China.
Department of Otorhinolaryngology Head and Neck Surgery, The Third Affiliated Hospital of Guangxi Medical University, Nanning, China.
Transl Cancer Res. 2025 May 30;14(5):3047-3056. doi: 10.21037/tcr-2024-2332. Epub 2025 May 12.
Prior research, characterized by small patient cohorts, has yielded limited understanding of the effects of radiotherapy (RT) on distant nasopharyngeal carcinoma (dNPC). Therefore, we aim to examine the impact of RT on survival outcomes in dNPC utilizing a large-scale population database.
Clinical data from 1,171 dNPC patients in the Surveillance, Epidemiology, and End Results (SEER) registry [2004-2019] was retrospectively analyzed. Among them, 227 (19%) did not receive RT, while 944 (81%) did. The primary outcome was overall survival (OS). Kaplan-Meier analysis was used to assess the survival of patients, and differences between treatment groups were evaluated using the Log-rank test and Cox's regression model. Nomogram was established to predict patient survival time and the model was evaluated using receiver operating characteristic (ROC) curves.
The median survival duration for all patients was 33 months, with a range spanning from 0 to 215 months. RT was associated with significantly improved OS [hazard ratio (HR): 0.35, 95% confidence interval (CI): 0.29-0.43, P<0.001]. According to the Cox proportional hazards model, the HR for patients who did not receive RT was 2.83 times higher compared to those who underwent RT. The nomograms for predicting 1-, 3-, and 5-year OS demonstrated moderately good calibration and discrimination, with a concordance index of 0.71. The areas under the curves (AUCs) of ROC for 1-, 3-, and 5-year OS were 0.762, 0.763, and 0.750 respectively.
Our research revealed the significance of RT in the treatment of dNPC, and RT can serve as an independent predictor of survival, which might contribute to the creation of guidelines for dNPC.
先前的研究以小样本患者队列为主，对远处鼻咽癌（dNPC）放疗（RT）效果的了解有限。因此，我们旨在利用大规模人群数据库研究RT对dNPC生存结局的影响。
回顾性分析了监测、流行病学和最终结果（SEER）登记处[2004 - 2019年]中1171例dNPC患者的临床数据。其中，227例（19%）未接受放疗，而944例（81%）接受了放疗。主要结局是总生存期（OS）。采用Kaplan-Meier分析评估患者生存率，并使用对数秩检验和Cox回归模型评估治疗组之间的差异。建立列线图以预测患者生存时间，并使用受试者工作特征（ROC）曲线评估模型。
所有患者的中位生存时间为33个月，范围为0至215个月。放疗与OS显著改善相关[风险比（HR）：0.35，95%置信区间（CI）：0.29 - 0.43，P < 0.001]。根据Cox比例风险模型，未接受放疗的患者HR比接受放疗的患者高2.83倍。预测1年、3年和5年OS的列线图显示出适度良好的校准和区分能力，一致性指数为0.71。1年、3年和5年OS的ROC曲线下面积（AUC）分别为0.762、0.763和0.750。
我们的研究揭示了放疗在dNPC治疗中的重要性，放疗可作为生存的独立预测因素，这可能有助于制定dNPC的治疗指南。
